Consult doctor without delay if you have any nasal problems

With terminologies such as Black Fungus and Mucormycosis scaring people, it is important to note that if patients who have recovered from COVID-19 have symptoms such as nasal obstruction, nasal discharge, facial pain, pain in the sinuses or redness of the eye, then the best thing for them would be to consult a doctor, especially an ENT specialist.

Since people are scared they rush to any doctor, who generally recommends an MRI scan. But the fungus usually affects the nasal cavity first, so it is always better to start the diagnosis from the nasal cavity. Later, the process can involve your heart, your eye and then from there it can affect your brain.

The first and foremost thing that an ENT doctor will recommend is a nasal endoscopy. After that,if there is any discharge or crust or already there is some blackish necrosis then ideally, we can take a biopsy or we can send for a fungal KOH scan.

The next thing that can be done is an MRI scan. MRI is a gold standard because, in MRI there are videos coming of a gadolinium contrast. This contrast goes wherever there is blood supply, so, places where there is no contrast that means that part of the tissue is eaten by the fungus.

Let's get to the difference

People have been using the term Black Fungus, but according to medical practitioners there is no such thing as black fungus. The correct medical term for the infection is 'mucormycosis'. Mucormycosis is a fungal infection which can be seen like gangrene, the tissue affected by the fungus becomes black and hence the layman's use of the term black fungus became common. But if noticed carefully the fungus itself is not black.

The organism is everywhere near you, in and out of your house. People who are more likely to be get affected are, patients recovering from the second wave of Covid and uncontrolled diabetes patients or inpatients with very low immunity.

Treatment of COVID-19 patients involves the use of steroids for boosting the level of sugar in their body. At the same time the ferritin level of the body increases. Mucromycosis has an affinity towards ferritin. Hence patients with all these problems are more likely to be affected by the fungus. The fungus blocks the blood vessels decreasing blood supply to the affected part of the body and hence that part gets necrosed and turns blackish.

Mucormycosis is a dangerous disease and should not be taken lightly. When compared to Covid (death rate 2%) the death rate by mucormycosis is as high as 30% and for patients suffering from both Covid and mucormycosis death rate may escalate to 70%.

DON'T PANIC

Now, what has happened in the present scenario is any small query is put up as a symptom of mucormycosis because people don't want to take chances. This in turn has caused everyone to become so tensed and worried about what could have been a small symptom of sino-sinus. What the people need to do is first visit an ENT doctor and get it checked, and, if necessary, get a test done. If the result is positive, patients need to be operated upon because it has to be removed just like gangrene.

We have to be vigilant and take proper preventive measures to stay safe. People need to increase their immunity, eat well and make sure that their immunity does not deteriorate. Patients who are diabetic should make sure that their diabetes is under control.

An early checkup may go easy on your pocket but a delay in taking prompt action might cost you anything between Rs. 5 and Rs 10 lakh. Treatment of mucormycosis is very expensive for the government--to treat one mucormycosis patient it has to spend around Rs 3 lakh. One vial of Liposomal Amphotericin B, the medicine required for treatment, costs right now around Rs 7,000.

There is no conclusive evidence that steroids used in treatment of Covid are causing mucormycosis. There may be a number of other causes. For example, the second wave has seen a shortage of oxygen. Reliance on industrial oxygen to meet the shortage could be one of the causes of increase in black fungus cases.

(The author is a consultant, ENT, Regal Superspeciality Hospital)